Health reps plead with Medicaid for support, funding

Local Medicaid health care providers are fighting funding cuts that will lower their reimbursement and decrease the number of people who qualify for their services.

Representatives from Harbor, one of four Medicaid Health Home providers in Northwest Ohio, attended a meeting to address the cuts at the Ohio Statehouse on May 15. The other providers are Unison Behavioral Health, Family Services of Northwest Ohio and The Zepf Center.

Jean Drees, marketing director for Harbor, said the purpose of the meeting was to ask the Department of Medicaid to extend funding for Health Home.

“The state is now trying to restrict and change the program, and that’s what we’re opposing,” Drees said.

Drees said she fears the repercussions of cutting funding this early. She said although progress may be slow at first, the Health Home providers are seeing success.

“We would no longer be allowed to offer the services if the funding does get cut,” Drees said. “What we would have then is what we’d be undoing, going back to basic services.”

Drees said the basic services threatened by the cut include primary health care. Under the improved Health Home model, patients would be granted more efficient primary care.

Detrimental decisions

Catina Harding, executive director for the Great Lakes Collaborative for Autism, said she feels cutting funding now would be detrimental.

“There’s just a ton of consequences,” she said. “Through Medicaid Health Home you have continual communication with doctors, schools, and it allows families to focus on being healthy rather than focusing on crisis.”

Harding’s organization does not directly deal with patients, but works on behalf of struggling families to look for solutions to their financial issues. In her testimony, Harding described the challenge an autism diagnosis presents to the average family.

“[Families] are told their child has autism, insurance does not cover the services they will need, and good luck finding the programs that will work for your family, because each child, adolescent and adult with autism is very different with very unique needs, behaviors and challenges,” Harding said.

Many of the over 3,000 beneficiaries of Harbor’s services qualify as having a “severe and persistent mental disorder,” which makes taking medications for routine issues such as diabetes a challenge.

“What [cutting funding] would mean is we would not be able to help them the way we’re currently helping them,” Drees said. “People with this diagnosis die 25 years earlier than the rest of the population. Not because they’re depressive, have anxiety disorders or bipolar disorders. They die because they cannot manage primary care issues.”

Drees said people who qualify for the type of aid available under the program can forgo more expensive emergency room visits thanks to on-call health consultants who manage vitals for clients.

“The data shows that this group of clients are extremely expensive to the system,” Drees said. “Their care is not very good, so it’s a new delivery service approach that we’re taking with a better serving of the population that needs help coupled with a better cost outcome.”

Harding said she sees cost benefits of maintaining the Health Home program, and urged board members to look at the numbers.

“They should put the criteria changes on hold until they look at the data out there to see what makes the most sense for the families in terms of serving their needs,” Harding said.

Drees said she believes the system Harbor uses is “in total line with where health care is going” on a national level.

“This is the right way to serve this population from a cost-effective perspective,” Drees said. “We’re moving them toward well-health, otherwise they’ll ride Medicaid for the rest of their lives.”

Looking forward, Drees said she hopes the higher powers in health care take a careful look at their priorities and see that the program will flourish with more time.

“We need to be able to prove outcomes and we’re only 18 months into the pilot,” Drees said. “The whole health care system is changing. For people who have never managed their primary care needs, it takes a while to make them healthier.”

Harding said she is unsure of whether her speech made the impact she wanted, but hopes that someone can provide a reason for funding cuts.

“It does not make any sense that you would take a model that was working for our most challenged community members just to cross a few numbers out of the budget,” Harding said. “And there’s no good explanation for that either. There’s no legitimate, good explanation for why that decision is being made.”